title: Isolated and spontaneous correction of proximal interphalangeal joint contractures in Dupuytren's disease: an exploratory analysis of the efficacy and safety of collagenase Clostridium histolyticum.
abstract: OBJECTIVE
  Dupuytren's contractures affecting proximal interphalangeal (PIP) joints are challenging to treat. We explored the effects of collagenase Clostridium histolyticum (CCH) on PIP joint contractures after injection of an affected metacarpophalangeal (MP) joint in the same finger and after injection of an isolated PIP joint contracture.
  
  
  METHODS
  Two patient subsets were evaluated: those with MP/PIP joints contractures in the same finger, but only the MP joint contractures were treated (Group A); and those with isolated PIP joint contractures that were treated (Group B). Endpoints included correction and improvement in contracture. Fixed-flexion contracture (FFC) and range of motion (ROM) were also assessed; adverse events (AEs) were monitored.
  
  
  RESULTS
  In Group A, 28 and 43 % of PIP contractures spontaneously corrected after the first and last injection of CCH, respectively, for MP contractures; 40 and 63 %, respectively, improved. In Group B, 31 and 39 % of PIP joint contractures corrected after the first and last injection of CCH, respectively, 56 and 66 %, respectively, improved. In Groups A and B, FFC improvements were largest after the last injection; ROM improvements were largest after the last injection in Group A and third injection in Group B. For 46 and 44 % of patients in Groups A and B, respectively, the first injection was the last injection. In Group B, the median (minimum, maximum) injections/joint was 1.0 (1.0, 4.0). Nearly all patients (98 %) experienced ≥1 AE; most were injection-site reactions.
  
  
  CONCLUSIONS
  The efficacy of CCH for improving PIP joint contracture was similar whether treated in isolation or after treatment of an MP joint contracture.
authors.affiliation: Wrightington Hospital, Hall Lane, Appley Bridge, Lancashire, WN6 9EP, UK, mikehayton@gmail.com.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Hayton
authors.forename: Ardeshir
authors.initials: A
authors.lastname: Bayat
authors.forename: Douglass S
authors.initials: DS
authors.lastname: Chapman
authors.forename: Robert A
authors.initials: RA
authors.lastname: Gerber
authors.forename: Piotr P
authors.initials: PP
authors.lastname: Szczypa
mesh_terms: D000368:Aged; D047009:Hathewaya histolytica / Q000201:enzymology*; D017364:Collagenases / Q000009:adverse effects / Q000627:therapeutic use*; D004387:Dupuytren Contracture / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D005385:Fingers / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016059:Range of Motion, Articular
chemical_list: D017364:Collagenases